Fractura de Essex-Lopresti bilateral: caso clínico

El síndrome de Essex-Lopresti es una patología poco frecuente que en muchas ocasiones pasa des - apercibida en fase aguda. Su tratamiento se basa en estabilizar la cabeza del radio para evitar su migración proxi - mal, no existiendo protocolos claros acerca de la actuación a nivel distal, de la membrana interósea o el papel del acortamiento del cúbito. Presentamos un caso de afectación a nivel de ambos antebrazos, uno en forma aguda con un tratamiento mediante osteosíntesis y otro crónico en el que se ha realizado una artroplastia de la cabeza de radio, un acortamiento del cúbito y una técnica de Adams para la estabilización distal, ambos con excelente resultado. En nuestra opinión la estabilización de la articulación radio cubital distal debe ser parte del tratamiento del síndrome de Essex-Lopresti y la técnica de Adams constituye una alternativa en aquellos casos en los que la reconstrucción directa no es posible.Essex-Lopresti syndrome is an uncommon condition which in many occasions it goes unnoticed in acute phase. Its treatment is based on stabilize the head of the radius to prevent its proximal migration but there is no clear protocols on the performance at the distal radio-ulnar joint, the interosseous membrane or the role of the shortening of the ulna. We present a case report of effects at the levels of both forearms, one in acute form, with a treatment with osteosynthesis and another that has been treated with an arthroplasty of the radius head, a shor - tening of the ulna and an Adams ? technique for distal stabilization, both with excellent results. In our opinion, the stabilization of the distal radio-ulnar joint should be part of the treatment of Essex-Lopresti syndrome and the Adams ? technique is an alternative in those cases in which the direct reconstruction is not possible

Geomorfología y paisaje en el ordenamiento territorial: valorizando el corredor inferior del río Mapocho

Considering the roles how biological corridor of the lower hydrological system of the Mapocho River, pointing to their integration in the urban planning of the respective communes from an ecologic, environmental and social perspective, is carried on a research about their geomorphological and landscape characteristics and the processes that are leading the evolution of the landscape. With this knowledge and from an ecosystemic perspective of the river territory, the limits of different homogeneous units were determined. Any geomorphological unit recognized, meaning also landscape systems, was characterized by its geology, sedimentology, soils and drainage, hydro-morphodynamic processes and human intervention, which allows through the determination of the quality and fragility of the geomorphic-landscape units, to establish land use proposals with their corresponding scopes on qualifications and restrictions. The resulting mapping contains implicit a proposal for land-use planning from the ecological planning point of view.    Considerando las funciones de corredor biológico del sistema hidrológico inferior del Río Mapocho, y apuntando a su integración a la planificación urbana de la intercomuna respectiva desde un punto de vista ecológico-ambiental y social, se reconocen sus características geomorfológicas y paisajísticas, y se establecen los procesos que lideran la evolución del modelado de las formas naturales. Con esta base se delimita el territorio fluvial desde una perspectiva ecosistémica y se determinan los límites de las diferentes unidades homogéneas resultantes. Cada unidad geomorfológica, en alta correspondencia con el sistema de paisajes, es caracterizada en función de su geología, sedimentología, suelos y drenaje, hidro-morfodinámica e intervención humana, lo cual permite mediante la determinación de la calidad y fragilidad de ellas, establecer propuestas de uso del suelo con sus correspondientes alcances sobre aptitudes y restricciones. La cartografía resultante contiene implícita una propuesta de ordenamiento del territorio desde el punto de vista de la planificación ecológica.  

Lesiones en el manguito rotador tras luxación anterior de hombro en pacientes mayores de 40 años.

Se ha realizado un estudio prospectivo de la evolución de 32 luxaciones anteriores de hombro en pacientes de más de 40 años con el objetivo de establecer la incidencia, localización y tipo de rotura del manguito rotador a causa de la luxación, conocer evolución clínica y establecer los criterios clínicos que nos permitan sospechar una rotura del manguito rotador, sin necesidad de recurrir a resonancia magnética (RM) de entrada. Los pacientes fueron sometidos a estudio mediante RM, clasificando las lesiones observadas en cinco grados en función de la extensión de la rotura, siendo el grupo 1 la integridad del manguito. El 90% de los casos presentó una rotura del manguito rotador asociada a la luxación. Tras un periodo de rehabilitación se demostró una diferencia significativa en la recuperación de la abducción en los pacientes con manguito íntegro, siendo un signo clínico de importancia para valorar el estado del manguito rotador.A prospective study of the evolution of 32 anterior dislocations of the shoulder in patients older than forty years has been done with the objective of establishing the incidence, location and kind of tear caused by the dislocation, to know the evolution and to establish the clinical parameters that allow us to suspect an injury of the rotator cuff without the help of magnetic resonance (MR) in the beginning. All the patients were studied with MR, doing a classification of the tears in five degrees, depending on the extension of the tears, being the group 1 the integrity of the rotator cuff. In 90% of the cases a rotator cuff tear has been found to be associated with the dislocation. After the rehabilitation, a significative difference in the recovery of the abduction has been demonstrated in the patients with integrity of the rotator cuff, being an important clinical sign to know the state of the rotator cuff

Performance of the CMS Cathode Strip Chambers with Cosmic Rays

The Cathode Strip Chambers (CSCs) constitute the primary muon tracking device in the CMS endcaps. Their performance has been evaluated using data taken during a cosmic ray run in fall 2008. Measured noise levels are low, with the number of noisy channels well below 1%. Coordinate resolution was measured for all types of chambers, and fall in the range 47 microns to 243 microns. The efficiencies for local charged track triggers, for hit and for segments reconstruction were measured, and are above 99%. The timing resolution per layer is approximately 5 ns

Performance and Operation of the CMS Electromagnetic Calorimeter

The operation and general performance of the CMS electromagnetic calorimeter using cosmic-ray muons are described. These muons were recorded after the closure of the CMS detector in late 2008. The calorimeter is made of lead tungstate crystals and the overall status of the 75848 channels corresponding to the barrel and endcap detectors is reported. The stability of crucial operational parameters, such as high voltage, temperature and electronic noise, is summarised and the performance of the light monitoring system is presented

Catastrophic NAD+ Depletion in Activated T Lymphocytes through Nampt Inhibition Reduces Demyelination and Disability in EAE

Nicotinamide phosphoribosyltransferase (Nampt) inhibitors such as FK866 are potent inhibitors of NAD+ synthesis that show promise for the treatment of different forms of cancer. Based on Nampt upregulation in activated T lymphocytes and on preliminary reports of lymphopenia in FK866 treated patients, we have investigated FK866 for its capacity to interfere with T lymphocyte function and survival. Intracellular pyridine nucleotides, ATP, mitochondrial function, viability, proliferation, activation markers and cytokine secretion were assessed in resting and in activated human T lymphocytes. In addition, we used experimental autoimmune encephalomyelitis (EAE) as a model of T-cell mediated autoimmune disease to assess FK866 efficacy in vivo. We show that activated, but not resting, T lymphocytes undergo massive NAD+ depletion upon FK866-mediated Nampt inhibition. As a consequence, impaired proliferation, reduced IFN-γ and TNF-α production, and finally autophagic cell demise result. We demonstrate that upregulation of the NAD+-degrading enzyme poly-(ADP-ribose)-polymerase (PARP) by activated T cells enhances their susceptibility to NAD+ depletion. In addition, we relate defective IFN-γ and TNF-α production in response to FK866 to impaired Sirt6 activity. Finally, we show that FK866 strikingly reduces the neurological damage and the clinical manifestations of EAE. In conclusion, Nampt inhibitors (and possibly Sirt6 inhibitors) could be used to modulate T cell-mediated immune responses and thereby be beneficial in immune-mediated disorders

Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients.Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method.Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO.Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids

Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%–50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality

Calibration of the CMS Drift Tube Chambers and Measurement of the Drift Velocity with Cosmic Rays

Peer reviewe

Search for massive resonances in dijet systems containing jets tagged as W or Z boson decays in pp collisions at √s=8 TeV

Peer reviewe